Surviving Cancer, Living With Pain?
Network - Spring 2008
By Sandi Stromberg
With two out of three adult cancer patients surviving their disease, researchers are finding they need to widen their focus beyond effective, life-saving treatments. Surviving with poor quality of life and heavy symptom burden is increasingly unacceptable in a world in which 22.4 million people have survived cancer.
Fatigue, cognitive deficit, sleep disturbance and neuropathic pain are just some of the side effects with which survivors must deal. Yet, historically, there has been little research to understand the biologic mechanisms that cause them, the patients who are most susceptible to developing them or what kind of interventions might alleviate them.
“The problem is that many areas of importance to patients, especially side effects, have not been funded by the National Cancer Institute or the National Institutes of Health,” says Charles Cleeland, Ph.D., chair of the Department of Symptom Research at M. D. Anderson.
Paving way for new studies
This situation has brought about new opportunities for cancer research: a recent alliance between a pharmaceutical company, AstraZeneca, and a research-oriented cancer center, M. D. Anderson, in which “AstraZeneca has given us full freedom to design these studies,” says Cleeland, who is co-principal investigator on this multifaceted study.
In the best of all worlds, these two entities would have joined hands long ago and worked in tandem to study and discover new treatments for cancer and the side effects of its treatments. However, collaborations between for-profit companies and non-profit institutions usually brought up the potential for conflict of interest.
So what has changed?
“Today, in the face of limited federal funding and squeezes on the NIH’s budget, research grants, especially in the area of reducing or preventing symptoms, are harder to obtain than ever before. Collaborating with AstraZeneca allows us to continue working toward helping our patients. But rest assured, M. D. Anderson and The University of Texas System have put extensive safeguards and conflict-of-interest policies and committees in place to help carefully cultivate relationships with the pharmaceutical industry,” Cleeland says.
The development of strategic alliance relationships such as this one between
M. D. Anderson and AstraZeneca helps to combine the unique strengths of both partners to more effectively bring the newest drugs to patients faster.
The pharmaceutical industry benefits by obtaining early input on clinical needs, insight on research and drug development and access to academe’s faculty expertise. Likewise, M. D. Anderson also benefits by gaining access to various resources as well as some of the industry’s top neuroscientists within the company.
Filling a critical need
One of the foremost side effects to be studied under the terms of this agreement is chemotherapy-induced neuropathy, a common problem for patients receiving certain kinds of chemotherapy, such as paclitaxel, docetaxel, cisplatin, oxaliplatin, vincristine, thalidomide and bortezimib. If two or more of these agents are given in combination, the toxicity and potential for nerve damage increases.
“For up to 40% of patients who experience this distressing problem, it may: a) limit the amount of chemotherapy he or she can receive, and b) become a chronic pain problem for some smaller percent of those patients,” says Allen Burton, M.D., professor and clinical medical director of M. D. Anderson’s Pain Management Center.
In honor of his contributions to improving the quality of life of patients through symptom research, Charles Cleeland, Ph.D., recently was awarded the 2007 American Cancer Society Trish Greene Quality of Life Award.
Together, he and Patrick Dougherty, Ph.D., professor in the Department of Anesthesiology and Pain Medicine, hope to identify neurobiologic differences between cancer patients who develop neuropathy and those who have little or no pain. This could give them a better understanding of the biologic mechanisms that cause this peripheral nerve damage, then help them design appropriate interventions.
“If we can limit toxic effects on the nervous system and thereby give full chemotherapy regimens, we may increase a patient’s survival, and hopefully also eliminate the long-term chronic symptoms that survivors deal with,” says Dougherty, co-principal investigator with Cleeland on these studies.
Reducing the symptom burden
This project also will study such treatment-related symptoms as cognitive deficit, fatigue and sleep disturbance, and explore potential common biologic mechanisms that may underlie these distressing symptoms.
This research also could lead to new treatments to prevent pain, extending the therapeutic value of current chemotherapies, as well as help in the development of new chemotherapies with less severe pain-related side effects.
“Our collaboration with AstraZeneca presents a unique opportunity to study ways of making cancer therapy much more tolerable,” Cleeland says. “Our overarching goal is to reduce the symptom burden of survivorship.”